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Review ArticleContinuing Education

V/Q Scanning Using SPECT and SPECT/CT

Paul J. Roach, Geoffrey P. Schembri and Dale L. Bailey
Journal of Nuclear Medicine September 2013, 54 (9) 1588-1596; DOI: https://doi.org/10.2967/jnumed.113.124602
Paul J. Roach
Department of Nuclear Medicine, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia
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Geoffrey P. Schembri
Department of Nuclear Medicine, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia
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Dale L. Bailey
Department of Nuclear Medicine, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia
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  • FIGURE 1.
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    FIGURE 1.

    (A). Example of patient with multiple bilateral PE. Ventilation and perfusion images show multiple mismatched perfusion defects. (B) Representative ventilation, perfusion, and V/Q quotient images. Dark areas on V/Q quotient images, denoting high V/Q ratio, are indicative of V/Q mismatch. (Reprinted with permission from (19).)

  • FIGURE 2.
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    FIGURE 2.

    (A–D) False-positive V/Q scan due to emphysema. Mismatch is evident in right upper lobe (arrows), but CT (E) shows cause to be emphysematous bulla. R = right; A = anterior; L = left. (Reprinted with permission from (14).)

  • FIGURE 3.
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    FIGURE 3.

    Representative SPECT/CT images in patient with colon cancer and dyspnea. SPECT shows matched defect in right lower lobe (arrows). CT shows this finding to correspond to previously undiagnosed metastasis.

  • FIGURE 4.
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    FIGURE 4.

    Representative SPECT/CT images in patient with multiple PE. Several mismatched defects are evident (arrows). CT shows no underlying structural abnormalities.

  • FIGURE 5.
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    FIGURE 5.

    Sagittal (left) and transaxial (right) perfusion, CTPA, and fused slices in patient with PE and lower lobe volume loss due to atelectasis. Although defect (red crosshairs) was initially localized to superior segment of right lower lobe, fusion accurately localizes defect to posterior segment of right upper lobe. (Reprinted with permission from (52).)

  • FIGURE 6.
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    FIGURE 6.

    Coregistered CTPA and perfusion SPECT scans (transverse slice) demonstrating extensive perfusion defects on SPECT. Findings correspond to proximal bilateral PE shown on CTPA (arrows) (Reprinted with permission from (52).)

  • FIGURE 7.
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    FIGURE 7.

    (A) Planar V/Q scan in patient with dyspnea. Single mismatched defect is seen at right base (arrow), classifying study as intermediate probability of PE. (B) Representative coronal SPECT slices show multiple mismatched defects (arrows) indicative of widespread PE. Patient had extensive deep venous thrombosis.

  • FIGURE 8.
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    FIGURE 8.

    (A) Anterior (left) and posterior (right) planar images in patient with right lung carcinoma (arrows). Boxes over upper, middle, and lower thirds of each lung approximate relative contribution of each region. Because of overlap of segments and differences in individual anatomy, accuracy is lacking. (B) Fused perfusion/CT images (top row) in coronal (left), transverse (middle), and sagittal (right) planes show perfusion defect (due to tumor, denoted with red crosshairs) in right upper lobe. Patient’s individual CT scan can be used to generate patient-specific lobar slices (middle row) in corresponding orthogonal slices and rotating maximum-intensity-projection images (left image, bottom row). SPECT/CT allowed accurate determination of each lobe’s relative contribution to overall ventilation (middle image, bottom row) and perfusion (right image, bottom row). LLL = left lower lobe; LUL = left upper lobe; RLL = right lower lobe; RML = right middle lobe; RUL = right upper lobe.

Tables

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    TABLE 1

    Typical Acquisition and Processing Parameters for V/Q SPECT*

    ParameterDescription
    SPECT acquisition3° steps over 360°
    Acquisition time per projection12 s (ventilation); 8 s (perfusion)
    CollimatorLow-energy, high resolution
    Matrix size128 × 128 (64 × 64 can also be used)
    ReconstructionOrdered-subset expectation maximization (8 iterations, 4 subsets)
    Postreconstruction filter3-dimensional Butterworth; cutoff, 0.8 cycles/cm; order, 9
    • ↵* Protocol from Royal North Shore Hospital, Sydney.

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    TABLE 2

    Summary of Strengths and Limitations of CTPA, V/Q SPECT, and V/Q SPECT/CT

    ParameterCTPAV/Q SPECTV/Q SPECT/CT
    SensitivityModerate-highHighHigh
    SpecificityVery highHighVery high
    Accuracy with abnormal radiograph findingUnaffectedSometimes affectedSometimes affected
    Ability to provide other diagnosesFrequentRareFrequent
    Incidental findings requiring follow-upFrequentRareLess frequent
    Radiation doseHighLowLow-moderate
    Possible allergic reactionYesNoNo
    Risk of contrast nephropathyYesNoNo
    Technical failure rateHigherRareRare
    Availability (especially outside routine hours)HighUsually lowerUsually lower
    Accuracy in pregnancyLowerHighHigh
    Accuracy in chronic PELowerHighHigh
    Performance in obstructive lung diseaseUnaffectedMay be affectedMay be affected
    Role and accuracy in follow-upLimitedVery goodVery good
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Journal of Nuclear Medicine: 54 (9)
Journal of Nuclear Medicine
Vol. 54, Issue 9
September 1, 2013
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V/Q Scanning Using SPECT and SPECT/CT
Paul J. Roach, Geoffrey P. Schembri, Dale L. Bailey
Journal of Nuclear Medicine Sep 2013, 54 (9) 1588-1596; DOI: 10.2967/jnumed.113.124602

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V/Q Scanning Using SPECT and SPECT/CT
Paul J. Roach, Geoffrey P. Schembri, Dale L. Bailey
Journal of Nuclear Medicine Sep 2013, 54 (9) 1588-1596; DOI: 10.2967/jnumed.113.124602
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  • Article
    • Abstract
    • ADVANTAGES OF SPECT OVER PLANAR IMAGING
    • V/Q SPECT
    • V/Q SPECT/CT
    • CONTROVERSIES
    • NON-PE APPLICATIONS AND FUTURE DIRECTIONS
    • CONCLUSION
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Keywords

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